MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IX, No 7, July 13, 2010
In This Issue:
1. Featured Article: How Babies Think
3. International Medicine: CyberKnife for private paying patients - not NHS members
4. Medicare: Social Security, Medicare and Medicaid are Bernie Madoff Ponzi Schemes
5. Medical Gluttony: The Cost of Everything the Consultant Recommended
6. Medical Myths: Don't Profits increase the cost of health insurance?
7. Overheard in the Medical Staff Lounge: Did Hell Freeze over last night?
8. Voices of Medicine: It's Not The Immigrants, Mr. President, It's Lawbreaking
9. The Bookshelf: THE MEMORY CURE
10. Hippocrates & His Kin: Sixty years of the NHS and Health Care is still not equal
11. Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words of Wisdom, Recent Postings, In Memoriam . . .
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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 7th Annual World Health Care Congress was held April 12-14, 2010 in Washington D.C. For more information, visit www.worldcongress.com. The future is occurring NOW. To read our reports of the 2008 Congress, please go to the archives at www.medicaltuesday.net/archives.asp and click on June 10, 2008 and July 15, 2008 Newsletters.
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1. Featured Article: How Babies Think, Scientific American, July 2010, By Alison Gopnik
Even the youngest children know, experience and learn far more than scientists ever thought possible.
■ Babies' and young children's cognitive abilities far surpass those that psychologists long attributed to them. They can, for instance, imagine another person's experiences and grasp cause and effect.
■ Children learn about the world much as scientists do—in effect, conducting experiments, analyzing statistics and forming theories to account for their observations.
■ The long helplessness of babies may be a . . . trade-off, a necessary consequence of having brains wired for prodigious feats of learning and creativity. —The Editors
Thirty years ago most psychologists, philosophers and psychiatrists thought that babies and young children were irrational, egocentric and amoral. They believed children were locked in the concrete here and now—unable to understand cause and effect, imagine the experiences of other people, or appreciate the difference between reality and fantasy. People still often think of children as defective adults.
But in the past three decades scientists have discovered that even the youngest children know more than we would ever have thought possible. Moreover, studies suggest that children learn about the world in much the same way that scientists do—by conducting experiments, analyzing statistics, and forming intuitive theories of the physical, biological and psychological realms. Since about 2000, researchers have started to understand the underlying computational, evolutionary and neurological mechanisms that underpin these remarkable early abilities. These revolutionary findings not only change our ideas about babies, they give us a fresh perspective on human nature itself.
Physics for Babies
Why were we so wrong about babies for so long? If you look cursorily at children who are four years old and younger (the age range I will discuss in this article), you might indeed conclude that not much is going on. Babies, after all, cannot talk. And even preschoolers are not good at reporting what they think. Ask your average three-year-old an open-ended question, and you are likely to get a beautiful but incomprehensible stream-of-consciousness monologue. Earlier researchers, such as the pioneering Swiss psychologist Jean Piaget, concluded that children's thought itself was irrational and illogical, egocentric and "precausal"—with no concept of cause and effect.
The new science that began in the late 1970s depends on techniques that look at what babies and young children do instead of just what they say. Babies look longer at novel or unexpected events than at more predictable ones, and experimenters can use this behavior to figure out what babies expect to happen. The strongest results, however, come from studies that observe actions as well: Which objects do babies reach for or crawl to? How do babies and young children imitate the actions of people around them?
Although very young children have a hard time telling us what they think, we can use language in more subtle ways to tease out what they know. For example, Henry Wellman of the University of Michigan at Ann Arbor has analyzed recordings of children's spontaneous conversations for clues to their thinking. We can give children very focused questions—for instance, asking them to choose between just two alternatives, rather than asking an open-ended question.
In the mid-1980s and through the 1990s, scientists using these techniques discovered that babies already know a great deal about the world around them. That knowledge goes well beyond concrete, here-and-now sensations. Researchers such as Renée Baillargeon of the University of Illinois and Elizabeth S. Spelke of Harvard University found that infants understand fundamental physical relations such as movement trajectories, gravity and containment. They look longer at a toy car appearing to pass through a solid wall than at events that fit basic principles of everyday physics.
By the time they are three or four, children have elementary ideas about biology and a first understanding of growth, inheritance and illness. This early biological understanding reveals that children go beyond superficial perceptual appearances when they reason about objects. Susan A. Gelman, also at Michigan, found that young children believe that animals and plants have an "essence"—an invisible core that stays the same even if outside appearances change.
For babies and young children, the most important knowledge of all is knowledge of other people. Andrew N. Meltzoff of the University of Washington showed that newborns already understand that people are special and will imitate their facial expressions.
In 1996 Betty Repacholi (now at Washington) and I found that 18-month-olds can understand that I might want one thing, whereas you want another. An experimenter showed 14- and 18-month-olds a bowl of raw broccoli and a bowl of goldfish crackers and then tasted some of each, making either a disgusted face or a happy face. Then she put her hand out and asked, "Could you give me some?" The 18-month-olds gave her broccoli when she acted as if she liked it, even though they would not choose it for themselves. (The 14-month-olds always gave her crackers.) So even at this very young age, children are not completely egocentric—they can take the perspective of another person, at least in a simple way. By age four, their understanding of everyday psychology is even more refined. They can explain, for instance, if a person is acting oddly because he believes something that is not true. . .
The Statistics of Blickets
In 1996 Jenny R. Saffran, Richard N. Aslin and Elissa L. Newport, all then at the University of Rochester, first demonstrated this ability in studies of the sound patterns of language. They played sequences of syllables with statistical regularities to some eight-month-old babies. For example, "bi" might follow "ro" only one third of the time, whereas "da" might always follow "bi." Then they played the babies new strings of sounds that either followed these patterns or broke them. Babies listened longer to the statistically unusual strings. More recent studies show that babies can detect statistical patterns of musical tones and visual scenes and also more abstract grammatical patterns.
Babies can even understand the relation between a statistical sample and a population. In a 2008 study my University of California, Berkeley, colleague Fei Xu showed eight-month-old babies a box full of mixed-up Ping-Pong balls: for instance, 80 percent white and 20 percent red. The experimenter would then take out five balls, seemingly at random. The babies were more surprised (that is, they looked longer and more intently at the scene) when the experimenter pulled four red balls and one white one out of the box—an improbable outcome—than when she pulled out four white balls and one red one.
Detecting statistical patterns is just the first step in scientific discovery. Even more impressively, children (like scientists) use those statistics to draw conclusions about the world. In a version of the Ping-Pong ball study with 20-month-old babies using toy green frogs and yellow ducks, the experimenter would take five toys from the box and then ask the child to give her a toy from some that were on the table. The children showed no preference between the colors if the experimenter had taken mostly green frogs from the box of mostly green toys. Yet they specifically gave her a duck if she had taken mostly ducks from the box—apparently the children thought her statistically unlikely selection meant that she was not acting randomly and that she must prefer ducks.
In my laboratory we have been investigating how young children use statistical evidence and experimentation to figure out cause and effect, and we find their thinking is far from being "precausal." We introduce them to a device we call "the blicket detector," a machine that lights up and plays music when you put some things on it but not others. Then we can give children patterns of evidence about the detector and see what causal conclusions they draw. Which objects are the blickets?
In 2007 Tamar Kushnir, now at Cornell University, and I discovered that preschoolers can use probabilities to learn how the machine works. We repeatedly put one of two blocks on the machine. The machine lit up two out of three times with the yellow block but only two out of six times for the blue one. Then we gave the children the blocks and asked them to light up the machine. These children, who could not yet add or subtract, were more likely to put the high-probability yellow block on the machine.
They still chose correctly when we waved the high-probability block over the machine, activating it without touching it. Although they thought this kind of "action at a distance" was unlikely at the start of the experiment (we asked them), these children could use probability to discover brand-new and surprising facts about the world. . .
These studies suggested that when children play spontaneously ("getting into everything") they are also exploring cause and effect and doing experiments—the most effective way to discover how the world works. . .
The brain region called the prefrontal cortex is distinctive to humans and takes an especially long time to mature. The adult capacities for focus, planning and efficient action that are governed by this brain area depend on the long learning that occurs in childhood. This area's wiring may not be complete until the mid-20s.
The lack of prefrontal control in young children naturally seems like a huge handicap, but it may actually be tremendously helpful for learning. The prefrontal area inhibits irrelevant thoughts or actions. But being uninhibited may help babies and young children to explore freely. There is a trade-off between the ability to explore creatively and learn flexibly, like a child, and the ability to plan and act effectively, like an adult. The very qualities needed to act efficiently—such as swift automatic processing and a highly pruned brain network—may be intrinsically antithetical to the qualities that are useful for learning, such as flexibility.
A new picture of childhood and human nature emerges from the research of the past decade. Far from being mere unfinished adults, babies and young children are exquisitely designed by evolution to change and create, to learn and explore. Those capacities, so intrinsic to what it means to be human, appear in their purest forms in the earliest years of our lives. Our most valuable human accomplishments are possible because we were once helpless dependent children and not in spite of it. Childhood, and caregiving, is fundamental to our humanity. ■
Alison Gopnik is professor of psychology and affiliate professor of philosophy at the University of California, Berkeley. She has done groundbreaking research into how children develop a "theory of mind," the ability to understand that other people have minds and may believe or want different things than they do. She helped to formulate the "theory theory," the idea that children learn in the same way that scientists do. Investigations of children's minds, she argues, could help us resolve deep philosophical questions such as the mystery of consciousness.
Alison Gopnik's Web site: alisongopnik.com
Photographs by Timothy Archibald
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2. In the News: Obama and Snooki, By John Nothdurft, Heartland Institute
Publisher: The American Spectator, Opeds, 07/01/2010
Today the first of President Barack Obama's 21 tax hikes to pay for his massively expensive health care law takes effect, levying a 10 percent tax on tanning salons. With this tax, the president once again breaks his promise not to raise taxes on Americans making less than $250,000 per year. In addition, this time he's targeting largely women-owned small businesses.
If you don't think taxes matter, look no further than Nicole "Snooki" Polizzi, a star on the hit MTV reality show Jersey Shore. The notably bronzed celebrity made headlines by saying, "I don't go tanning anymore, because Obama put a 10 percent tax on tanning." She added, "I feel like he did that intentionally for us. McCain would never put a 10 percent tax on tanning." Sen. John McCain responded on Twitter, stating, "u r right, I would never tax your tanning bed! Pres Obama's tax/spend policy is quite The Situation but I do rec wearing sunscreen!"
The tax wasn't even in the health care bill until it became a ninth-inning replacement for the equally unfair "botax," which would have placed a 5 percent tax on elective cosmetic surgeries. Just as subsidies and targeted tax credits are handed out to favored businesses, targeted tax hikes take aim at narrowly defined targets. Both are political instruments subject to intense lobbying, not sound fiscal policy.
The tanning tax will have its greatest effect on women, who are not only more likely to use tanning beds but also own 67 percent of the nation's indoor tanning businesses, according to The International Smart Tan Network. The Congressional Joint Committee on Taxation estimates the tax will raise $2.7 billion over 10 years. That is just a drop in the ocean compared with the expected cost of the health care bill, now a staggering $1.053 trillion over 10 years. The negligible revenue the tanning tax will bring in makes the fundamental unfairness of this and other "sin" taxes even more obvious. . .
When government uses tax policy to discriminate against legal products, it unjustly manipulates a market already rich with an abundance of healthy and less healthy choices. Ultimately, higher taxes on selected "sin" items, such as tanning salons, are just another example of politicians taking away more of our personal and financial liberties.
John Nothdurft (email@example.com) is the budget and tax legislative specialist for the Heartland Institute.
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UK Doctors Barred From Using Innovative Machine by Tabassum Rahmani
Publisher: The Heartland Institute, 07/09/2010
Mount Vernon Cancer Centre in London, England has become the first National Health Service (NHS) hospital to buy a CyberKnife machine, a new robotic radiosurgery system, but England's specialized commissioning group (SCG) has banned NHS patients from being treated with the device.
According to Dr. James G. Schwade, executive director of the Cyberknife Center of Miami, the Cyberknife is a system for delivery of highly concentrated radiation to perform image-guided radiosurgery.
"The Cyberknife may be useful for many cancers, including primary and metastatic lung cancer, brain, spine, and other central nervous system tumors, and tumors in the liver, pancreas, prostate, and elsewhere," said Schwade. "It is often useful in patients who have previously had other treatments and have persistent or recurrent tumors. But it is increasingly being used as a primary treatment in many sites, specifically prostate and lung cancer."
Authorities Rule: Not Cost-Effective
Cancer sufferers from Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk, and Cambridgeshire have taken to the pages of England's newspapers to complain about this decision. Although doctors may recommend the treatment for their patients, only private patients whose insurers agree to pay will have access to the devices—not those who have only traditional NHS coverage.
There are two CyberKnife machines now in use in the UK, both located at private hospitals in Harley Street, London, where patients pay more than £20,000 pounds for a course of treatment (roughly $30,000).
According to Trevor Myers, the SCG's chief operating officer, its clinical advisory group (CAG) was given a presentation by some of Mount Vernon's doctors about their Cyberknife machine, in an attempt to achieve approval.
"The CAG came to the conclusion that there is not enough evidence in regard to both the clinical and cost-effectiveness of the service. Given the limited resources in the NHS, it is vital that we buy services that have been proven to be clinically effective in accordance with national policy," Myers said.
NICE Study in Progress
It is possible NHS could reconsider. . .
According to a spokesperson for NICE, the institute intends to undertake a "fast-track" evaluation of the system and similar technologies, and it expects to report on its findings later this year.
Tabassum Rahmani (firstname.lastname@example.org) writes from Dublin, California.
NHS does not give timely access to healthcare, it only gives access to a waiting list if the treatment is approved by the government.
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Health Alert: Health and Debt: The Commission, Part II NCPA, by John Goodman, PhD
The International Monetary Fund is warning that the U.S. national debt will exceed 100% of GDP within the next five years, and economists both here and abroad are expressing alarm. The debt problem is mainly an entitlements problem and the entitlements problem is mainly a health care problem. How serious is it?
President Obama has appointed a commission on the federal debt (National Commission on Fiscal Responsibility and Reform), mainly focused on Social Security, Medicare and Medicaid. To signal his seriousness about this venture, the president has even gone so far as to put the newly passed health reform bill on the negotiating table — although the ink on the new law is barely dry.
As I explained at The Health Care Blog the other day, here's the bottom line: Our entitlement problems all stem from the fact that these programs are run like Bernie Madoff chain letters. Since payroll tax revenues are spent rather than invested, workers are accumulating benefits that are not paid for. Implicitly, we are creating huge obligations for generations not yet born — people who never agreed to be part of the scheme and who will surely be worse off if they participate.
. . . Real reform means converting our pay-as-you-go systems into funded systems for both Social Security and Medicare. Real reform means creating systems in which each generation saves and invests and pays its own way.
As of last year's Social Security/Medicare Trustees report, these two programs had an unfunded liability in excess of $107 trillion (see the table), about 6 ½ times the size of the entire economy. This is the excess of promises we have made over and above expected dedicated taxes and premiums. To avoid draconian benefit cuts or tax increases in future years we would need to have that $107 trillion in the bank, earning interest today. But of course we do not.
. . . A different way of accounting is to use the method private companies and state and local governments now have to use. If we halted these programs tomorrow, collecting no more taxes and allowing no more benefit accruals, how much do we owe people for benefits they have already earned? Answer: $52 trillion, more than three times the size of GDP!
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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The economic hazards of obtaining an opinion (Consultation).
Every physician needs to obtain a consultation on occasion. Some are straightforward such as a fracture needing an orthopedist or a vision problem needing an ophthalmologist. In the broad field of internal medicine, a general internist may just need some guidance on a difficult diagnostic problem. When this is resolved, the specialist should back off and let the personal physician handle the case. The internist may be juggling a half-dozen diagnoses and the subspecialists may have expertise in only one.
The problem arises when a consultant makes a confirmatory diagnosis and several recommendations of varying importance. The personal physician will take the recommendations under advisement and proceed as his or her clinical judgment deems necessary, in view of the several problems being managed. The consultant is not in charge of managing the case - only in giving his opinion or recommendations.
A vascular surgeon, for instance, who finds a small aortic aneurysm that requires minimal further attention may suggest, just to be safe, that the patient come back in six months to do another ultrasound. I've seen patients who have had ultrasounds twice a year for ten years with no change in the size of the minimal aneurismal dilatation. These are the times that health care costs may increase ten fold while politicians are talking about a five or ten percent containment, which won't happen with their micromanagement of health care. Occasionally a patient, after one or two follow ups, will sensibly decline if there has been no change. This changes the economic impact so silently that no congressman or senator will ever notice.
However, the patient who demands to read all of the consultation reports in detail and shares them with his spouse, relatives, friends and neighbors, will feel threatened by all of the opinions that might endanger his life, including how he could die in his own bed with his spouse not knowing until the next morning. Under these circumstances, he will insist on the repeat exams every three or six months as recommended. The increased anxiety may cause an early coronary attack and the aneurysm would be blamed without the confirmation of an autopsy. In our society where people spend 53 hours a week on media, the projections of the anxious would determine future government plans as understood by our elected congress.
However, it is a major step, a significant jump, to go from a media induced health care plan to one base on reason and medical facts. This is a jump our society may never be able to make. We keep on helping our patients make this leap.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Sunday, November 15th, 2009
In his address to Congress on health care reform, Barack Obama cited Alabama as a state in which almost 90% of health insurance is controlled by one company. "[A]n additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchanges."
The "People Before Profits" slogan also reflects the belief that it is not only inefficient and costly but morally wrong to make a profit from providing health insurance or medical care. (Also see Myth 22.)
By far, the dominant players in the health insurance market are nonprofits, especially Blue Cross and Blue Shield. The largest insurer in virtually every state is a nonprofit (John Lott, FOXNews.com 9/16/09).
About 55% of insured employees receive coverage through their employer's "self-insured" plan. For Alabama, the correct percentage insured by one company is 36%, not 90%, when the employees of self-insured companies are in the denominator.
Getting rid of profits would not reduce costs, Lott writes. Costs would go up because without profits there would not be the same incentives to hold them down. Profits are the reward for figuring out what consumers want. "Profit maximization combined with competition is the only reliable way we know to keep costs down," states Baylor economics professor Earl Grinols (ibid.).
A reality check on health insurers and profit: (more…)
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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Reading an article in the newspaper on the table in the Staff Lounge: "President Obama has appointed a commission on the federal debt (National Commission on Fiscal Responsibility and Reform), mainly focused on Social Security, Medicare and Medicaid. To signal his seriousness about this venture, the president has even gone so far as to put the newly passed health reform bill on the negotiating table - although the ink on the new law is barely dry."
Dr. Rosen: Is there really Ice on the Ground in DC in July?
Dr. Sam: I'll believe that when DC really freezes over in July.
Dr. Edwards: Hey, let me go out and catch a falcon.
Dr. Dave: We are living in a world of fiction.
Dr. Edwards: Maybe the kid in the big White House is growing up and realizing that he can't spend greenbacks as if they were green paper issues.
Dr. Rosen: It truly is a fictitious world. The county is going broke and laying off health care workers and eliminating critical jobs. The cities are going broke and laying off police, firefighters and other safety workers. The states are going broke and closing clinics, cutting university salaries, laying off professors, and limiting the number of students that can enroll. Those that are able to enroll are facing increased tuition and fees.
Dr. Edwards: You don't really think Obama's monstrous health care bill, that will double taxes for our children and triple taxes for our grandchildren, will really be pulled back?
Dr. Paul: I certainly hope not. Everyone is exaggerating the effects.
Dr. Edwards: How can you say that, Paul? Even Obama's own finance director has stated that taxes will have to go up even though they were allegedly supposed to go down.
Dr. Paul: How else though are you going to cover the poor?
Dr. Dave: Well, don't we have the huge Medicaid program for all poor people?
Dr. Paul: Why am I seeing so many children whose parents have a difficult time paying their bills?
Dr. Dave: Don't most of your patients already have Medicaid?
Dr. Paul: There are more Medicaid patients standing in line waiting to be seen.
Dr. Dave: If you have a waiting list for Medicaid patients already, what's going to happen when the president puts another 35 million people into the program?
Dr. Paul: At least they will be covered and have an even chance of being seen.
Dr. Sam: Isn't that what the lawsuit that went to the Canadian Supreme Court a couple of years ago was all about?
Dr. Paul: How's that?
Dr. Sam: The patient was in severe pain and after waiting two years for a hip arthroplasty was still not able to obtain care, so he took his case all the way to the Canadian Supreme Court.
Dr. Rosen: Yes, wasn't that interesting. The patient and his doctor knew they had the court exactly where they couldn't move in another direction. After completing all the arguments, the Supreme Court waited a full year to give its report: Canadian Medicare does not give access to health care; it only gives access to a waiting list. *
Dr. Sam: And if Obama is successful in implementing his outrageous plan, which doubles the number in Medicaid, all the new Medicaid patients, plus all the current Medicaid patients, will no longer have any better access to health care, similar to Canadian Medicare. So we've gone the disastrous way of Canada through the back door. The 30 million or so current Medicaid recipients have moved from access to care to access to the waiting list, and the 35 million or so new Medicaid recipients will now have access to a waiting list. They will probably be worse off than they are now in receiving care.
Dr. Rosen: Getting back to Paul's statement of how his Medicaid patients have difficulty with their finances, have you had informal discussions with them before or after your appointments? Or escorted them to their cars?
Dr. Paul: I'm too rushed to have that kind of talk.
Dr. Rosen: My Medicaid patients frequently have two cars and live in upscale locales.
Dr. Edwards: It looks like a matter of priorities. If you sit at home most of the time watching TV, wouldn't you want a 60-inch flat screen?
Dr. Sam: Sometimes it's enlightening to escort patients to their car to see what they are driving. I'd say the most expensive cars in our doctor's lot are about equally divided between the Medicaid and so-called middle class patients.
Dr. Rosen: I once tried to accompany a patient to the car and he stopped in the hallway and asked what I was doing. He invited me to return to my office. So I turned to go back to my office and a minute later followed from a distance as I watched him get into a late model Jaguar and drive off.
Dr. Sam: So you were seeing him for half your usual fee and he's driving a car twice as expensive as you are driving.
Dr. Edwards: It helps when you have several sources of income and the government doesn't know about two of them.
Dr. Rosen: It also explains a doctor's perception of welfare and government largess while getting blamed for insensitivity or greed.
* --Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791 http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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It's Not The Immigrants, Mr. President, It's The System Set Up to Distribute Benefits of Lawbreaking
By Arizona Physician, Jane M. Orient, M.D. JAPS, July 6th, 2010
On July 1, Barack Obama spoke of the immigrants who helped build our country—such as my great-grandparents. They passed through public health screening, obeyed the law, worked hard, and never got welfare benefits. They learned the English language and American history. Some even carried the Constitution of their beloved adopted homeland in their pocket throughout their lives. They asked only for the opportunity to contribute.
Should we, as Obama suggested, break down the bureaucratic barriers that hinder such people? Absolutely. That is not what the controversy is about.
The issue is illegal immigration—lawbreaking. Controversy is inflamed by marches of angry people, aggressively waving a foreign flag, insulting Americans in a foreign language, and demanding to "take back" the property and earnings of Americans.
Illegals circumvent public health screening, bringing once banished foreign organisms with them. The most serious one is probably multi-drug resistant tuberculosis, which one can catch on a bus. Head lice are far more common than previously in schools. Dengue has reached the continental U.S. and the parasite that causes Chagas disease now infests more than 40 percent of the kissing bugs found near Tucson, compared with only 4 percent in 1964.
Then there's property and environmental destruction in the Arizona desert. Ranchers' land is trampled, and strewn with tons of garbage and human excrement.
Worse, there are guns—including military assault rifles. Americans are warned to stay out of the Buenos Aires National Wildlife Refuge because it is occupied by heavily armed invaders, who smuggle drugs and humans. Phoenix, Arizona, is perhaps the kidnapping capital of the world, with heavily armed contingents invading homes and carrying off people for ransom.
While proclaiming that we are "a nation of laws," Obama didn't mention how the U.S. federal government encourages lawlessness. One way is by forcing the private sector to care for illegals free of charge, through the Emergency Medical Treatment and Active Labor Act (EMTALA). Physicians on a hospital staff are required to serve these patients immediately—even if they have scheduled surgeries or an office full of waiting patients.
When hospitals in Border States complained that this unfunded mandate could cause them to close (as many actually have), the federal government offered some reimbursement for services provided under EMTALA to illegals. Hospitals, however, could not inquire about immigration status—they had to somehow divine it without asking, and file a claim without telling.
Doctors owe a duty of confidentiality to their patients. The Oath of Hippocrates states: "All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and never reveal."
Some things, however, ought to be revealed, and by law physicians must report them. These include certain infectious diseases, gunshot wounds, suspected abuse, and evidence of an impending crime. While the government demands access to more and more sensitive information about citizens from their health records, including illegal drug use, sexual preference, psychiatric history, and gun ownership, one is not allowed to ask basic questions about immigration status. This is a double standard.
Doctors are not law enforcement agents. Their duty is simply to treat patients—even known enemy combatants or criminals. They may not, however, help people evade the law.
Federal law may actually encourage them to do so. According to anonymous reports, "community health centers," which are generously funded by federal tax dollars, not only provide treatment to illegals but also may help them obtain many other welfare benefits to which they are not entitled. Bending or violating the law might keep enrollments expanding and the federal dollars flowing and the staff paid. Immigration officials look the other way, and anyone who dared to raise questions would likely be branded as a "racist." ("ObamaCare," by the way, will expand the reach of such centers from about 5 percent to 10 percent of the population.)
In contrast to Obama's examples, like Jews fleeing Eastern Europe, this time we're not facing just a migration, but an influx having many hallmarks of a foreign invasion. . .
If the United States cannot or does not enforce its laws, Lady Liberty's lamp will no longer beckon to the people throughout the world who are "yearning to breathe free."
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
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THE MEMORY CURE by Thomas H. Crook III,
Ph.D. & Brenda Adderly, M.H.A.,
Pocket Books, New York, 1998, 287 pages, $24. ISBN: 0-671-02642-9
Thomas H. Crook III, an international expert on memory retention and loss, along with Brenda Adderly, M.H.A., a health care researcher, writer and former staff assistant under Dr. C Everett Koop, explain "What is Memory?" and "Why we Forget."
In each of our lives there comes a time when we are afflicted with more than simple forgetfulness. We begin to forget important things. Since less than 10 percent of us get Alzheimer's disease or irreversible memory loss, there is a large area of loss for which many proposals of alleviation are being investigated. The authors treat the problem of age associate memory impairment (AAMI), which affects all of us past age 40. Dr. Crook has conducted research that actually measures memory loss.
There are four types of memory. Immediate memory lets you look up a telephone number, dial it, and then forget it. Short-term memory or "concentrating" stays with us for minutes or hours but may have no value to us next week. We can usually remember seven chunks of information, give or take two, at the same time. For instance, the letters S-E-E-C-I-A-C-B-S can be thought of as nine chunks (hard for most people to memorize), or as three chunks, SEE, CIA, and CBS (much easier to recall).
Long-term or "permanent" memory stores knowledge about our friends, job, locations, and (hopefully) most of our medical education. It too fades, but more gradually, and can be recalled. The more often recalled, the more permanent it becomes. Long-term memory can store a quadrillion bits of information (1015 bits--is that really a million times more than my gigabyte hard drive?)
Finally, remote or procedural memory is essentially unforgettable knowledge, much of which seems to have been with us all our lives, and that we always recall this side of Alzheimer's disease. This includes our names, our family, our long-time friends, childhood memories, even how to recite verses learned in grade school. Remote memory is usually not in the forefront of our consciousness until we need it. We then transfer it into long-term memory. If portions of this are forgotten—such as, after 40 years, the loss of our native tongue—it can be restored in a matter of weeks if the previous environment is reproduced, say by a trip back to our ancestral home. It is then available in long-term memory again.
These four types of memory--immediate, short-term, long-term, and remote--decline at different rates with advancing age. Thus, the degree to which age-related loss needs to be "cured" varies also. The first and last types of memory, immediate and remote, decline relatively little. We may have to concentrate a little harder on immediate recall but it is an insignificant absolute figure. At the other end of the scale, remote memory is so deeply embedded that we retain it unless our minds are badly eroded by disease. Even then, many basal memories persist . . .
Most declines come in short-term and long-term memory. Of these, the declines in short-term memory are more apparent and observable: the inability to remember names, faces, appointments, to recall where we put our keys--all very noticeable both to the persons forgetting and to family and friends. . .
-Del Meyer, MD
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The differences in health between the rich and poor in Britain are not only among the greatest in the western world, but they are as great as they were in 1948, "when health care was de facto nationalized precisely to bring about equalization," -Theodore Dalrymple
Socialism never brings equality in health or riches, just equal misery and poverty.
Many of the proposed budget cuts New Yorkers may have to stomach in coming months will hit neighborhoods and senior centers.
Announcing the proposed cuts Thursday, Mayor Bloomberg said 50 senior centers would face the shutter. There are currently 301 centers citywide serving approximately 28,000 senior citizens daily. The plan would affect around 1,600 seniors, says Christopher Miller, a spokesman for the Department of Aging.
All government programs outspend their tax resources and eventually end up giving great pain.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read John Goodman's Blog on Cost-Sharing: The Good, the Bad and the Ugly.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Just released is John Graham's Blog: Health Insurers Want Obamacare Faster than Obama Does.
• The Mercatus Center at George Mason University (www.m.ercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, you may want to tackle, perhaps after you've had a Scotch, the Breakdown of Medicare Expenditures.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month, you might focus on Grace-Marie Turner on Doctors Will Flee Medicare's Low Payments, Onerous Rules.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read Fact Check of Medicare Promotional Brochure.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the classic interview with the Founder: Reason Magazine Interview with Leonard E. Read.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Read the latest newsletter Bad Medicine: The Real Costs & Consequences of ObamaCare.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read "The real solution to Quebec's health care woes is to make people responsible for a portion of the health care services they use and the proposed health deductible does just that."
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. We would also caution that should Mitt Romney ever run for National office again, he would be dangerous in the cause of freedom in health care. We would also advise Steve Forbes to disassociate himself from this institution. Talk radio has suggested that Mitt should apologize for the Massachusetts Debacle and run against Obama in 2012. However, one who has made such a great error in judgment should never be afforded the opportunity to make another such great error that affects 300 Million Citizens. Two people with nearly identical errors against human freedom running against each other would make this a non-contest between two socialists. What has America wrought?
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. If you're new to the Hillsdale mission, you must read the message from President Arnn on why they do not accept any federal or state loans. This month, read Charles Kesler, Editor, Claremont Review of Books on The New Deal. The last ten years of Imprimis are archived.
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
Coercion of individuals ultimately leads either to slavery or to strife: Obama's health care agenda is not compatible with his Nobel price for peace. - Alphonse Crespo MD
Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery. - Winston Churchill - English Statesman, 1874-1965
I didn't come into politics to change the Labour Party. I came into politics to change the country. - Tony Blair - English Statesman, 1953
Some Recent Postings
Dennis Hopper: Scenes from a Tumultuous Life – By Joe Morgenstern, WSJ, May 30, 2010
When the news of Dennis Hopper's passing came on a radiant California morning - he died at his home in Venice, where he'd lived for much of his tumultuous life - my first impulse was to pull some DVDs off the shelf and savor his signature performances yet again - those terrifying performances from "Apocalypse Now," "Blue Velvet" and "Speed"; the endearing role of the alcoholic basketball coach that won him an Oscar nomination in "Hoosiers," and of course his drug-addled Billy in "Easy Rider," a movie he directed that has become an emblem for an entire countercultural era.
But I also searched out one of his several photographs in the catalog of a huge and influential show of Los Angeles art that the Pompidou Center in Paris mounted four years ago. The show was called "Los Angeles: 1955-1985" - a stretch of time in which Hopper was a ubiquitous part of the L.A. art scene - and his photograph, called "Double Standard," was the show's most prominent icon, displayed for all of Paris to see outside the Pompidou in a gigantic blow-up.
The photo says a lot about his humor, his cool intelligence and his sharp eye. Shot from inside a car in Los Angeles in 1961, it's a wide-angle, black-and-white image of a Standard gas station. (It also says a lot about what's happened to the price of gas — 30 cents a gallon way back then.) The station is surmounted by a pair of Standard signs - thus the double standard of the title - and the photo plays with another piece of double vision, a truncated view of cars in a rear-view mirror. It's tempting to apply the title to Hopper himself. He was a serious artist who first worked as a painter, then as a fine-art photographer, but also a gleefully unserious entertainer who could shock you, creep you out and scare you half to death. In everything he did, though, he pursued the single standard of making something memorable out of the world that raged around him, and the life that raged within him.
On This Date in History - July 13
On this date in 1787, the United States was able to formulate the law that has been basic to our geographical and national growth ever since. It was called the Northwest Ordinance, enacted by Congress to outline how the territory north of the Ohio River should be governed and how it would ultimately evolve into states that would be admitted to the Union. That basic law established the idea of self-governing territories as a way station to statehood and also established the requirement that U.S. territories have freedom of worship, trial by jury and public education. All in all, not a bad day's work. If on this anniversary we can contribute however slightly to what they started, we can consider ourselves fortunate.
On this date in 1865, Horace Greeley, a famous editor, wrote in The New York Tribune, "Washington is not a place to live in. The rents are high, the food is bad, the dust is disgusting and the morals are deplorable. Go West, young man, go West and grow up with the country."
After Leonard and Thelma Spinrad
Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.